Provider Demographics
NPI:1053400853
Name:FISCHER, RICHARDS & WALKER, PA
Entity type:Organization
Organization Name:FISCHER, RICHARDS & WALKER, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:910-353-5234
Mailing Address - Street 1:17 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-353-5234
Mailing Address - Fax:910-353-1999
Practice Address - Street 1:17 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-5234
Practice Address - Fax:910-353-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890237AMedicaid
NC0237AOtherBLUE CROSS BLUE SHIELD OF NC
863135JACKSONVILLEOtherUNITED CONCORDIA
526060MOREHEADCITYOtherUNITED CONCORDIA
NC8902986Medicaid
NC02986OtherBLUE CROSS BLUE SHIELD NC
2429959Medicare ID - Type Unspecified